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Generic Lyrica® price drop and other updates ― significant MSA savings
September 9, 2019
The Workers’ Compensation Medicare Set Aside (WCMSA) portal has been updated to reflect new lower-cost generic formulations of Lyrica®, as well as additional medication price decreases (updates listed below).
The month of August brought price drops for the generic medications pregabalin, baclofen, oxycodone-acetaminophen, ramelteon and solfenacin. Pregabalin is the generic form of Lyrica, which is commonly used to treat neuropathic pain and is frequently prescribed in workers’ compensation claims. Oxycodone-acetaminophen is a combination of a short-acting opioid and acetaminophen used to treat pain. Baclofen is a widely-used skeletal muscle relaxant prescribed to relieve muscle spasms. Ramelteon is used to help with insomnia. And, solifenacin is indicated for bladder muscle dysfunction with symptoms of urinary urgency, incontinence and frequency.
Effect on WCMSA costs
As more generic manufacturers bring products to market, price pressure tends to bring down costs. The chart below shows the generic products that we expect will significantly reduce many MSA drug allocations. Cases that include the below medications will see significant decreases to the Medicare Set-Aside (MSA) as a result of these price reductions.
| Medication | Manufacturer | Strength | NDC Number | New unit price |
Previous unit price |
Percent decrease |
|---|---|---|---|---|---|---|
| Baclofen | Eywa | 20 mg | 71930000712 | $0.55 | $1.01 | 45.35% |
| Oxycodone-acetaminophen | Eywa | 325 mg-7.5 mg | 71930004612 | $0.71 | $2.57 | 72.45% |
| Oxycodone-acetaminophen | Eywa | 325 mg-10 mg | 71930004712 | $0.78 | $3.37 | 76.85% |
| Pregabalin | Major | 25 mg | 904699104 | $1.58 | $8.42 | 81.20% |
| Pregabalin | Major | 50 mg | 904699261 | $0.90 | $7.58 | 88.06% |
| Pregabalin | Major | 75 mg | 904700061 | $0.92 | $7.58 | 87.84% |
| Pregabalin | Major | 100 mg | 904700161 | $1.01 | $7.58 | 86.70% |
| Pregabalin | Major | 150 mg | 904700261 | $1.14 | $7.58 | 84.95% |
| Pregabalin | Major | 200 mg | 904700304 | $2.00 | $8.42 | 76.30% |
| Pregabalin | Major | 300 mg | 904700504 | $2.06 | $8.42 | 75.57% |
| Ramelteon | Zydus Pharm. | 8 mg | 70710134401 | $13.99 | $15.56 | 10.10% |
| Solifenacin | Celltrion | 5 mg | 72606000901 | $0.34 | $3.86 | 91.28% |
| Solifenacin | Celltrion | 10 mg | 72606001001 | $0.34 | $3.86 | 91.28% |
Please note that REDBOOK Average Wholesale Price (AWP) is subject to change and this pricing is subject to an increase or decrease in the future.
Optum Workers’ Comp and Auto-No Fault (OWCA) recommendation
CMS will utilize the lowest AWP when reviewing WCMSAs, therefore the lower pricing of these drugs will impact prescription costs. It is our recommendation that carriers, TPAs and claim handlers review cases where the above-noted medications are prescribed to determine the benefit from the decreased costs. We will proactively reach out to our clients in reference to previously completed WCMSAs where these medications were allocated.
Future updates
We continually monitor the RED BOOK® Average Wholesale Price (AWP) changes for the most common medications in WCMSAs, as well as generic medications that come to market, and will keep the industry informed.
As an established Medicare Secondary Payer (MSP) compliance services provider, one of OWCA’s goals is to keep clients and the property and casualty insurance industry informed of changes affecting Medicare Secondary Payer (MSP) compliance and WCMSAs.
Sources:
- RED BOOK http://www.micromedex.com/products/redbook/awp/
- WCMSA portal https://www.cob.cms.hhs.gov/WCMSA/login
